R.H. Jucá1, M. Akabane2, G. Soares6, T. Pimentel3, D. Souza4, L. Consoli5, A. Calle2, S. Jucá7, I. Boin1 1State University of Campinas, Liver Transplant Department, Campinas, SÃO PAULO, Brazil 2Federal University of Juiz de Fora, School Of Medicine, Juiz De Fora, MINAS GERAIS, Brazil 3Federal University of Pernambuco, School Of Medicine, Recife, PERNAMBUCO, Brazil 4TriHealth Good Samaritan Hospital, Cincinnati, OHIO, USA 5Federal University of Bahia, Salvador, BAHIA, Brazil 6Metropolitan University of Santos, Santos, SÃO PAULO, Brazil 7University Center of Votuporanga, Votuporanga, SÃO PAULO, Brazil
Introduction: Marijuana is the most commonly used recreational drug in the world. However, such use is considered a contraindication for liver transplantation (LT), and many LT centers will not list patients with a history of marijuana use. The effect of this drug on LT recipients remains unclear. This systematic review and meta-analysis assess the impact of marijuana use on outcomes after LT.
Methods: We searched PubMed, EMBASE, Scopus, Cochrane Central, and Web of Science databases and compared patients with a history of marijuana use (MJ) with those who have never used marijuana (NMJ) assigned to LT. Pooled outcomes included post-LT 1-year survival, overall survival, 1-year graft survival, and overall graft survival. Secondary endpoints were to compare the odds of MJ and NMJ being listed for LT and the odds of being transplanted. Statistical analysis was performed using R version 4.1.2 with a random effects model.
Results: We included 13 studies with a total of 12,269 LT recipients, of whom 2,656 (21.6%) were MJ and 9,613 (78.4%) were NMJ. Pooled outcomes showed no statistical difference between MJ and NMJ in post-LT 1-year survival (OR 1.32; 95% CI 0.92-1.88; P = 0.131), overall survival (OR 1.16; 95% CI 0.85-1.57; P = 0.346), 1-year graft survival (OR 4.92; 95% CI 0.07-331.75; P = 0.245), and overall graft survival (OR 2.24; 95% CI 0.48-10.49; P = 0.31). However, a subgroup analysis demonstrated lower odds of 1-year survival in current marijuana users compared to former marijuana users (OR 0.41; 95% CI 0.17-0.99; P = 0.05). Secondary endpoints shows that MJ have lower odds of being listed for LT (OR 0.63; 95% CI 0.45-0.89; P= 0.024), but there is no difference in the odds of receiving the transplant (OR 0.65; 95% CI 0.21-2.02; P = 0.354) compared to NMJ.
Conclusion: Our meta-analysis suggests that there is no difference between MJ and NMJ in post-LT 1-year survival, overall survival, 1-year graft survival, overall graft survival and odds of receiving the transplantation. However, MJ are less likely to be listed for L compared to NMJ.